Transcript Ear III, KSU student.ppt

Chronic otitis media
Chronic otitis media
Dr. Farid Alzhrani
Assistant professor
Consultant of Otolaryngology, head and neck surgery
King Abdulaziz University Hospital
Dr. Farid Alzhrani
Chronic otitis media
Objectives
• Definition and classifications
• Otitis media with effusion
• Adhesive otitis media
• Chronic suppurative otitis media
Dr. Farid Alzhrani
Chronic otitis media
Anatomy
Dr. Farid Alzhrani
Chronic otitis media
Definition
• Inflammation of the middle ear.
• May also involve inflammation of mastoid.
Dr. Farid Alzhrani
Chronic otitis media
Classifications
• Chronic Non Suppurative Otitis Media
1. Otitis media with effusion “OME”
2. Adhesive otitis media
• Chronic Suppurative Otitis Media “CSOM”
1. Tubotympanic (Safe)
2. Atticoantral (Unsafe)
Dr. Farid Alzhrani
Chronic otitis media
Chronic Non Suppurative
Otitis Media
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
The pathogenesis of OME :
• Multifactorial .
• Eustachian tube dysfunction.
• Bacterial and virus infections.
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
• Middle ear filled with serous or mucoid fluid
• No purulence
• Often present after acute otitis media is treated
appropriately with antibiotics
• Most will clear within 3 months
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
• Previously thought sterile.
• 30-50% grow in culture.
• over 75% PCR +
• Usual organisms.
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
Etiology :
Bacteria
•
Strep pnuemonia
•
Moraxella cat.
•
Haemophilus influ.
Virus
• RSV
• Rhinovirus
• Parainfluenza virus
• Influenza virus
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Chronic otitis media
Acute Otitis Media
Resolution
Persistent
effusion
Acute Perforation
+
Otitis Media
Resolution
+
Healing
Chronic suppurtive otitis
media
Unsafe
Safe
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
Estimates of residual effusion:
• 70% @ 2 wks
• 40% @ 4 wks
• 20% @ 8 wks
• 10% @ 12 wks
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
Diagnosis :
• History.
• Clinical Examination.
• Tuning fork tests.
• Audiological assessment.
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
• Tuning fork test ( Weber and Renine test)
• Audiological assessment:
1. Tympanometry
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
Audiological assessment:
2. B-Pure tone audiogram
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
 Medical Treatment of OME :
• Observation – many European countries wait 6-9
months prior to placement of ear tubes.
• Antibiotics
– Meta-analysis shows beneficial short-term
resolution of OME
• Audiogram at 3 months with persistent effusion to
determine impact on hearing
Dr. Farid Alzhrani
Chronic otitis media
Otitis Media with Effusion
(Chronic non-suppurative Otitis Media)
Surgical treatment (Tympanostomy Tubes ) :
• Bypass Eustachian tube to ventilate middle ear.
• Indication : chronic OME >3mos with hearing loss
and/or speech delay is an indication for
tympanostomy tube placement.
Dr. Farid Alzhrani
Chronic otitis media
Adhesive otitis media
(Chronic non-suppurative Otitis Media)
• Lack of middle ear ventilation results in negative pressure
within the tympanic cavity.
• The ear drum retracts onto structures within the middle
ear.
Dr. Farid Alzhrani
Chronic otitis media
Adhesive otitis media
(Chronic non-suppurative Otitis Media)
• The result of long standing Eustachian tube dysfunction.
• The drum loses structural integrity and becomes flaccid.
• Contact between the drum and the incus or stapes can
cause bone erosion at the IS joint.
• Can sometimes be treated with tympanostomy tubes.
Dr. Farid Alzhrani
Chronic otitis media
Chronic suppurative otitis media with
and without cholesteatoma
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Chronic otitis media
Chronic suppurative otitis media
3D :
• Duration > 3 months despite treatment
• Discharge mucopurulent otorrhea
• Deafness Perforation /Ossicular chains
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Chronic otitis media
Chronic suppurative otitis media
Pathogenesis :
• ET dysfunction
• Poor aeration
• Mucosal edema and ulceration
• Capillary proliferation
• Osteitis
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Chronic otitis media
Chronic suppurative otitis media
Etiology :
• Pseudomonas aeruginosa.
• Staphylococcus aureus.
• Proteus species.
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Chronic otitis media
Chronic suppurative otitis media
Classification :
Chronic suppurative otitis media
Tubo-tympanic type (safe)
Attico- antral (un safe)
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Chronic otitis media
Chronic suppurative otitis media
A- Tubotympanic type (Safe) :
• Simple perforation.
• Intermittent non offensive non
bloody ear discharge.
• On examination (central
perforation ).
Dr. Farid Alzhrani
Chronic otitis media
Chronic suppurative otitis media
B- Attico-antral (unsafe) :
• Chronic ,Scanty, offensive
and bloody ear discharge.
• On examination marginal
perforation.
• You may see cholesteatoma.
Dr. Farid Alzhrani
Chronic otitis media
Cholesteatoma
• Cholesteatomas are epidermal inclusion cysts of the
middle ear and/or mastoid with a squamous epithelial
lining.
• Contain keratin and desquamated epithelium.
Dr. Farid Alzhrani
Chronic otitis media
Cholesteatoma
• Can be congenital or acquired
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Chronic otitis media
Cholesteatoma
Pathogenesis of cholesteatoma :
Natural history is progressive growth with erosion of
surrounding bone due:
• Pressure effects.
• Osteoclast activation.
Dr. Farid Alzhrani
Chronic otitis media
Cholesteatoma
Diagnosis :
• History
• Examination
- Otoscopic
- Microscopic
- Tuning fork test
• Investigation
- Audiological assessment
- Radiological assessment
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Chronic otitis media
Cholesteatoma
Cholesteatoma Imaging :
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Chronic otitis media
Treatment
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Chronic otitis media
Chronic suppurative otitis media
Chronic suppurative otitis media without
cholesteatoma ( safe )
A — Ototopical antibiotics.
B — Surgical repair of the TM perforation.
Dr. Farid Alzhrani
Chronic otitis media
Chronic suppurative otitis media
A— Ototopical Medications :
• Antibiotic only otic drops
Floxin (ofloxacin)
• Antibiotic with steroid otic drops
Ciprodex (ciprofloxin and dexamethasone)
Cipro HC (ciprofloxin and hydrocortisone)
Dr. Farid Alzhrani
Chronic otitis media
Chronic suppurative otitis media
B — Surgical repair of the TM perforation :
• Myringplasty
• Tympanoplasty
Dr. Farid Alzhrani
Chronic otitis media
Chronic suppurative otitis media
— Ossicular Chain Reconstruction :
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Chronic otitis media
Chronic suppurative otitis media
Chronic suppurative otitis media with
cholesteatoma (Unsafe)
Surgery
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Chronic otitis media
Cholesteatoma Surgery :
Mastoidectomy ( CWU & CWD )
Dr. Farid Alzhrani
Chronic otitis media
Thank you
Dr. Farid Alzhrani